Virological and histological evaluation of intestinal samples in COVID-19 patients

Table 1 Baseline characteristics of the biopsy group

Characteristic	All patients, n = 30	Patients with GI symptoms at onset, n = 19	Patients without GI symptoms at onset, n = 11	P value
Median age in yr, mean (range)	65 (41-90)	60 (44-90)	78 (41-89)	NS
Sex as women:men (%)	7:23 (23.3:76.7)	4:15 (21.0:79)	3:8 (27.3:72.7)	NS
COVID-19 classification
Mild, n (%)	0	0	0	NS
Moderate, n (%)	30 (100)	19 (100)	11 (100)	NS
Coexisting illness
Hypertension	9 (30.0)	6 (31.6)	3 (27.3)
Diabetes mellitus	4 (13.3)	3 (15.8)	1 (9.1)
Cardio-cerebrovascular disease	5 (16.7)	3 (15.8)	2 (18.2)
Previous malignant tumor	2 (6.7)	1 (5.3)	1 (9.1)
Chronic obstructive pulmonary disease	3 (10.0)	2 (10.5)	1 (9.1)
Chronic kidney disease	3 (10.0)	2 (10.5)	1 (9.1)
Obesity	2 (6.7)	2 (10.5)	0
Chest CT
Negative, n (%)	4 (13.3)	3 (15.8)	1 (9.1)	NS
Bilateral distribution of GGO with or without consolidation, n (%)	16 (53.3)	9 (47.4)	7 (63.6)	NS
Unilateral distribution of GGO, n (%)	2 (6.7)	1 (5.2)	1 (9.1)	NS
Bilateral interlobular septal thickening, n (%)	8 (26.7)	6 (31.6)	2 (18.2)	NS
Median time from first positive NPS (range), d	10 (1-25)	8.0 (1-25)	12.0 (3-24)	NS
SARS-CoV-2 RNA in feces1, n (%)	6/14 (42.9)	4/11 (36.4)	2/3 (66.7)	NS
SARS-CoV-2 RNA in RNA-preservation medium rectal mucosa biopsy2, n (%)	0	0	0	-
SARS-CoV-2 RNA in FFPE rectal mucosa biopsy3, n (%)	0	0	0	-
Histological examination
Glandular architecture: Normal/altered, n (%)	30/0 (100/0)	19/0 (100/0)	11/0 (100/0)	NS
Edema of the lamina propria: Absent/slight, n (%)	4/26 (13.3/86.7)	3/16 (15.8/84.2)	1/10 (9.1/90.9)	NS
Inflammatory lymphoplasmacytic infiltration in the lamina propria: Mild/moderate, n (%)	28/2 (93.3/6.7)	18/1 (94.7/5.3)	10/1 (90.9/9.1)	NS
Eosinophilic granulocytes in the lamina propria: Absent/occasional/scattered, n (%)	10/18/2 (33.3/60.0/6.7)	7/10/2 (36.8/52.6/10.7)	3/8/0 (27.3/72.2/0)	NS
Neutrophil granulocytes in the lamina propria: Absent/rare, n (%)	28/2 (93.3/6.7)	18/1	10/1 (90.9/9.1)	NS
Enterocyte damage: Absent/present, n (%)	30/0 (100/0)	19/0	11/0 (100/0)	NS
Clinical outcome, n (%)
Discharged	30 (100)	19 (100)	11 (100)	NS
Died	0	0	0	NS

¹Available in 14 cases.

²Available in 23 cases.

³Available in 30 cases.

SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; GI: Gastrointestinal; NPS: Nasopharyngeal swab; SD: Standard deviation; FFPE: Formalin-fixed paraffin-embedded; GGO: Ground glass opacities; COVID-19: Coronavirus disease 2019; CT: Computed tomography.

Table 2 Baseline characteristics of the surgical specimen group

Characteristic	Patient no. 1	Patient no. 2	Patient no. 3	Patient no. 4	Patient no. 5	Patient no. 6
Age in yr	93	76	78	96	56	62
Coexisting illness	COPD, CVD	COPD, metastatic colon cancer	COPD, CVD, chronic kidney disease	COPD, hypertension	Psychiatric disease, obesity	Acute myeloid leukemia
COVID-19 classification	Moderate	Moderate	Mild	Mild	Moderate	Moderate
Thorax CT imaging	Bilateral distribution of GGO with consolidation	Unilateral distribution of GGO with consolidation	Bilateral distribution of GGO with consolidation	Unilateral distribution of GGO with consolidation	Bilateral distribution of GGO with consolidation	Bilateral distribution of GGO with consolidation
Time from first positive NPS	10	1	8	1	20	7
Reason for admission	COVID-19	Spontaneous pneumothorax	COVID-19	Intestinal occlusion	COVID-19	Chemotherapy for acute myeloid leukemia
Reason for surgical treatment	Rectal perforation after enema	Fecal peritonitis from perforated colon cancer	Fecal peritonitis from perforated diverticulitis	Small bowel obstruction secondary to bridle	Ischemic colitis	Acute abdomen
Surgical treatment	Colorectal resection and end-colostomy	Right colectomy and end-ileostomy	Sigmoid resection and end-colostomy	Segmental intestinal resection	Total colectomy and ileostomy	Appendectomy and sigmoid resection
GI symptoms at onset	No	No	No	No	No	Diarrhea
SARS-CoV-2 RNA in FFPE tissue/viral load (n° copies/microg)	No	29	No	No	No	< 25
Histological examination
Glandular architecture	Normal	Normal	Normal	Normal	Normal	Normal
Edema of the lamina propria	Slight	Absent	Slight	Slight	Slight	Absent
Inflammatory lymphoplasmacytic infiltration in the lamina propria	Mild	Mild	Mild	Mild	Mild	Moderate
Eosinophilic granulocytes in the lamina propria	Occasional	Occasional	Occasional	Occasional	Occasional	Occasional
Enterocyte damage	Absent	Absent	Absent	Absent	Absent	Absent
Vasculitis	Absent	Focal	Absent	Absent	Absent	Focal
Granulocyte, macrophage and plasma cell infiltrate in the muscle wall and adipose tissue	Absent	Moderate	Absent	Absent	Absent	Severe
Clinical outcome	Died	Died	Died	Died	Died	Died
Time from surgical treatment in d	6	4	4	35	17	20

GI: Gastrointestinal symptoms; COPD: Chronic obstructive pulmonary disease; CVD: Cardiovascular disease; NPS: Nasopharyngeal swab; FFPE: Formalin-fixed paraffin-embedded; GGO: Ground glass opacities; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; COVID-19: Coronavirus disease 2019; CT: Computed tomography.